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M. Luisa Canals PhD, MD. E-mail: lcanals@comt.es

TRAINING COURSE ON MARITIME HEALTH, VININAM & UBO Haiphong - Vietnam, 20-26, Feb. 2006. Fishing industry issues: International and National implications. Environmental characteristics and Risk Prevention. M. Luisa Canals PhD, MD. E-mail: lcanals@comt.es

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M. Luisa Canals PhD, MD. E-mail: lcanals@comt.es

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  1. TRAINING COURSE ON MARITIME HEALTH, VININAM & UBO Haiphong - Vietnam, 20-26, Feb. 2006 Fishing industry issues: International and National implications. Environmental characteristics and Risk Prevention M. Luisa Canals PhD, MD. E-mail: lcanals@comt.es Maritime Health Occupational MD, ISM Tarragona - Spain; Co-ordinator of the Postgraduate URV Course “University Specialist on Maritime Health; Former IMHA President (International Maritime Health Association); Former SEMM President, Tech. & Scientific Direction of SEMM (Sociedad Española de Medicina Marítima)

  2. Main contents of the presentation: Global vision of fishing as an occupational activity and its health relations. - International implications: ILO Conventions, IMO STCW-F … , Scientific societies IMHA … - Psychosocial factors Occupational risk prevention - Related to fishing tasks, environmental conditions … - National implications: Organization in Spain - Research “SEGUMAR" study in Spain

  3. Global vision of fishing as an occupational activity and its health relations • Ergonomics: Physic R: vibration, ventilation, noise • Hygiene on Board: Biological R: sanitation, water, food • Medical Fitness Exams: Health surveillance --- individual and collective epidemiology, COMPULSORY in Spain • Welfare and social aspects: mood, personal and occupational (Stress, fatigue …) • Safety – Survival: Disasters protection … • Training– risk prevention(O.health education)

  4. Internacional Labour Organization:Conventions OIT/ILO/BIT - Fishing Ind. • C 112. Minimum age (1959) • C 113. Medical Fitness Examination of fishermen • C 114. Fishermen enrolment • C 125. Competence certificates (1966) • C 126. Accommodation ----- R 7. Hours of work (1920) R 126. Professional training (1966) ----- Tripartite Meetings of Experts – 1999 – 2003 – 2004 … 2005 Superconvention + a complementary Recommendation have not been approuved because one vote. Internacional Maritime Organization:STCW-f

  5. I M H A W O R K S H O P S • Infectious Diseases, Antwerp 1999 • Cruise Medicine I, Miami 2000 • Practical Guide on Maritime Medicine, Vigo • Cruise Medicine II, Philadelphia • Health & Occup. Risk Prevention in Harbours, Barcelona, 2002 • Telemedicine, Rome • Health in the Fishing Industry, Cádiz, 2002 • 7th ISMH: 4 Seminars (G.B. Aspects, Med. Exam. Standards, Occupational accidents & Diseases, Maritime Activities), Tarragona, April 2003 • Continuing Education in Maritime Health, Barcelona, Nov. 2003 • Working at Sea, Psychological Health Problems, Riga, May, 2004 • Collection and Validation of Data in Maritime Medicine, Brest, July 2004 • Drug and Alcohol Policies, Odessa, Sept 2005

  6. IMHA WS: Gral.: S. Fdo (Cádiz-Spain), 2002 & Psychosocial Aspects: Riga (Latvia), 2004 • Directly related to fishing tasks (monotonous, variable, unsafe, uncertainty, …) • Overwork, rhythm, time pressure, especial conditions (fatigue, nocturne work, number of crewmembers …) • Sensation of control (stress, no decision …) • Environmental conditions, work equipment, multiple risks and expositions: accidents • Culture & organization: loneliness, interpersonal relations, role conflicts, lack of safety in work, low salaries, hard work, immigration, interferences with family life, social value …

  7. Psychosocial factors characteristics – A work culture in the fishing industry – Difficulties in risk prevention: • Personal, attitud: fatality resignation, environmental, lack of training … • Organizacional: group relation, salary based on the catch, lack of rest, insuficient crew, family, multicultural, rights??? • Institucional: inspection, ergonomics, competence conflicts, rules and regulations, small ships ???

  8. Fishermen: work related exposures • Access: risk different levels - to jump

  9. Fishermen: work related exposures • to walk on board: risk of slipping, strings, cables and other things like fish … on deck, water, grease, narrow spaces ….

  10. Fishermen: work related exposures • While fishing: trawling doors, pulleys, cables , nets ... falls, bruises, contusions, smashed, crushed ...

  11. Fishermen: work related exposures • Different risks according to the type of fishing and tasks

  12. Fishermen: work related exposures • Environment: noise, isolation, fatigue, hot, cold, nocturnes, stress, bad weather

  13. PREVENTION: recommendations E.g. Knees and back pain • Change position while working, balanced weight, feet position, to facilitate movements. • Adapt ergonomics till find the height to the efforts needed ------ • Relax muscles: exercises • Suitable equipment: clothes, shoes, … • Combine ergonomics of the ship and psycho-sociology of fishing work tasks

  14. Training(first-aid and medical care on board) • IMO: STCW Convention[Ch. VI: sections A-VI/4.1 minimum for all seafarers (pre-sea training) and 4.2 for persons in charge of medical care on board ships] (1978,1995) … • Directive 92/29/EEC [health, medical chest, medical assistance, safety, training]RD 258/1999 ... in Spain. • 31/1995 Occupational Risk Prevention Law,special RD for fishing ships > 15-18 GT …

  15. Health Education

  16. Campaigns

  17. BOTIQUÍN A CAJÓN 2 R.D. 258 B.O.E. 24/02/1999 BOTIQUÍN A CAJÓN 3

  18. The system of health care for seafarers and fishermen in Spain An integrated system on board and ashore Hospital Ships The Spanish Radio-Medical Advice Center

  19. Coordination • Data base

  20. The maritime health programme combines Health care & Prevention(A common computerised data base of medical examinations, hospitalizations ,rediomedical consultations, repatriations…) • On board: - Hospital ships taking care of the fishing fleet - Telemedicine RMA … by Radio (from 1979 in Spain) • In the port of call: and even abroad • Occupational or General Practitioners

  21. SPAIN: Instituto Social de la Marina (1919) National and connected system: medical care, prevention, training, welfare, social ... • It belongs to the State (Labour and Social Affair Ministry) About 100 doctors in the Maritime Health Programme (1984) • 35 Coastal Maritime Health Centres and 7 Abroad. Data base net. • Radio-Medical Advice Centre, Hospital Ships ... Training centre in Bamio – Galicia - Spain

  22. Spanish doctors abroad (because of the fishing fleet) • St. Pierre et Miquelon (1968) - St John’s (1970-1998) / • Beira (Mozambique 1989 -1994) • Nouadhibou (Mauritania - 1970) * • Dakar (Senegal - 1972) • Luanda (Angola - 1973) * • Walbis Bay (Namibia - 1973) * • Seychelles 1987 - Mahe …. • -Madagascar – Monbasa (Kenia) • - Ship • Abidjan (Ivory Coast - 1992) (*) some few years interrupted activities because of war, logistics.

  23. The Spanish Radio-Medical Advice Center

  24. Centro Radio-MédicoEspañol Proportion calls:1 merchant /13 fishemen Diseases: reumathology-MS, digestive, neurology, dermatology, bad defined. • Satellite, 1.5 consultations /case Accidents: Deck 76.8%, Engine 8.7%

  25. 309 77 500 55 510 5 158 155 116

  26. Videos

  27. Research: e.g SEGUMAR project Introduction:the SEGUMAR project is a research about the general state of the Andalusian fishing fleet from the point of view of the safety and the prevention of occupational risks. As part of this survey we analyze the health of the fishing personnel (morbidity, use of medications and lifestyles), work related accident and some aspects of the life at sea related with fatigue. Methods:Cross-sectional study with proportional sampling by conglomerates. Questionnaire of health and lifestyles were administered to a sample of 247 workers in 19 of the 23 Andalusian ports.

  28. Results in coastal fishing: It's a population of middle age (40 years) with 17% of workers with declared pathology. Within the main problems of health, respiratory, digestive and musculoskeletal illnesses were the most frequently presented. The use of medications on shore is high, analgesics, antibiotics and antacid were the most widely used. Approximately 56% smoked, 8,5% of the fishermen recognizes consumption of illicit drugs and 6,5% with a consumption pattern "regular". During the periods of boarding, medicines consumption reaches to 20% of the fishermen and 6% show worsening of their health, emphasizing the digestive problems and mental health problems with no conditions of family isolation were verified. 76% of the workers has suffered some injuries on board during their labour life, and a 43% of labour low them for injuries at sea.

  29. Health status damage is due in most cases to the worsening of previous medical pathologies, • and less to incident problems , emphasizing the musculoskeletal, digestive and mental health problems. • A 76% of the fishermen have had some accident on board during their labor life, and a 43% of them had sick leaves for injuries on board.

  30. Conclusions: • Working injuries, actinic keratoses and lesions in areas of exposed skin, rhinosinusitis, bronchitis obstructive and high consumptions of medicines, and tobacco were associated with fishing. • The recognized pattern of illicit drugs consumption doesn't show excessive differences regarding the values registered in Spanish adult population. • The injury rate in our environment is high but similar to the registers in other studies on fishing population. • The concern about the fishing, and the long work shifts are factors that the fishermen relate to the labor fatigue. The diet on board should be related to the digestive illnesses and with the work shifts to the labor fatigue. Coastal fishing

  31. CONCLUSIONS • In any country we have to make an effort to adapt health services to seafarer’s needs, deep sea and coastal fishermen should not be forgotten • More research on their health has to be implemented, we can share our experiences in the next International Symposium MH. Denmark, June, 2007

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